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Joint Troubles

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By Will Brink

"Joint Troubles"

One of the most common problems faced by strength training athletes is joint pain. "Oh my shoulder is killing me" or "my knee has been bothering me for months" or "I have been living on pain killers to get rid of this ache in my elbow" are common complaints that can be heard in any gym at any time. Oddly enough however, this topic is not covered very often in most bodybuilding/fitness magazines. Maybe the topic is just not all that "sexy" or "cutting edge," but if you're one of the thousands of people whose gains in muscle are being side tracked by joint troubles, then you don't give a damn about sexy or cutting edge-you just want relief!

In the past few years I have noticed an increase in letters and e-mail from people complaining about their joints. In all honesty, I would estimate 80% or more of most bodybuilders joint pain is totally avoidable. If you look at people who have chronic joint pain, nine out of ten times you can see why they would have an aching appendage that causes them pain. More often that not, they (1) rarely warm up adequately, (2) they train too long and/or too often, (3) they use overly heavy weights/low reps more often than they should, (4) they don't take time off to allow their joints, tendons, muscles, etc., to recuperate from heavy workouts, (5) they use less than perfect form during heavy lifts, (6) they don't take in adequate nutrients, or (7) all of the above!

Now of course we have all had an ache or pain in a knee, elbow , or other joint at times, but chronic long term pain is another story. This article is going to assume that the reader has joint pain NOT because he (or she) is doing any one of the above seven common mistakes, but has joint pain due to some other factor out of their control. If you warm up and stretch thoroughly, train for no longer than an hour three-four days per week, cycle your weights and reps, take time off when you need it, have good form, take in adequate nutrients, and still have joint problems... then this might be the article for you.

Types of joint problems

There are of course different types of problems that cause common joint pain in athletes and "normal" people alike. Bursitis, tendinitis, various types of arthritis, and other afflictions, can be the cause of a person's aching joints. Briefly, here is a description of the most common types and causes of joint pain that afflict athletes:

Arthritis: There are many different forms of arthritis. The two most common are osteoarthritis and rheumatoid arthritis. Of the two, osteoarthritis is by far the most common to bodybuilders and other athletes. Caused by wear and tear on the joints, osteoarthritis is characterized by a deterioration of the cartilage at the ends of the bones. The once smooth cartilage becomes rough thus causing more and more friction and pain. Left untreated and unchecked, this can become very debilitating for the hard training athlete. Chronic osteoarthritis has ended the career of numerous athletes.

Bursitis: In our joints there are small fluid filled sacks called bursae. The bursae's job is to assist in the muscle/joints movement by cushioning the joints and bones against friction. If these sacks become inflamed and/or injured due to various causes (see above training mistakes), a chronic pain called "bursitis" can result. It's most often found in the shoulder or elbow (A.K.A tennis elbow) but can also be found in other joints of the body. It hurts like hell and can ruin a workout quickly if left untreated.

Tendonitis: Tendonitis is probably the most common cause of pain to bodybuilders and other athletes and is (luckily) the easiest to treat. However, if left untreated and the person just "works through the pain," it can become a real problem that will put a quick end to your gains in muscle. Basically, tendinitis just means the tendon(s) around a joint have become severely inflamed from overuse, micro injury, etc. Though it might sound simple enough, for people who suffer from chronic tendinitis it's no joke and a real pain in the...joint!

Treatment options

Again, this article is going to assume that the reader warms up properly before working out, does not severely overtrain, yada, yada, yada, as mentioned in the beginning of this article. If the reader (you?) is in the gym all day, thinks one set on the bench press is a warm up, and feels anything over 3 reps is high rep training, than you need go no further to find the answers to what's bothering your joints!

The treatment options we are going to look at relate to natural compounds, or mixtures of natural compounds, that could save a person with aching joints years of pain and possibly even more. Unfortunately, the treatments offered by traditional medicine at this time are generally of little use to highly active people. Most of the treatments for joint problems address the symptoms (pain, swelling, etc) rather than the cause and can often make the problem worse in the long run. Non-steroidal anti- inflammatories, cortical steroid injections, joint replacement, and the always useful "stay off it" advice does not tend to yield the results most athletes want.

If you look at the names of the aforementioned types of joint problems, you will notice they all end with the term "itis," as in tendin-itis, arthr-itis, and burs-itis. The suffix "-itis" means "inflammation of " according to The American Medical Association Encyclopedia of Medicine. Knowing this, you can see that bursitis means inflammation of the bursea sack, tendinitis means inflammation of the tendons, and arthritis means....well you get the point. Medical terms for afflictions that end in "-itis" tell us that though the causes and manifestations are different, the final problems is one of inflammation. Inflammation is characterized by pain, swelling, redness, and less obvious symptoms. This leads us finally to our list of natural compounds/products that might just save the joints of the person reading this article who thought their workouts would never be the same because their joints are giving them so much trouble. These products tend to address not only the symptoms of the problem-that is the inflammation-but the underlying causes as well.

Jello Anyone?

As strange as it might seem, the main ingredient (gelatin) in good old Jello might be just what the doctor ordered for painful joints. Gelatin has been market world wide for many years as a food and as a supplement. Gelatin is made from animal collagen. In all animals-including man- collagen is an essential structural protein that forms an important part of bones, tendons, and connective tissues. It is a tough insoluble protein that is essential for keeping the many cells and tissues of the body together. Gelatin contains an exceptionally high content of two amino acids which play an important part in collagen formation, namely proline and glycine.

In fact, it takes 43 grams of dried egg whites or 35 grams of dried non fat milk or 89 grams of lean beef to equal the amount of proline in just 10 grams of hydrolyzed gelatin. Though the body can form these two amino acids on its own, it has been suggested that under certain conditions the rate of synthesis may be insufficient to provide essential body requirements and degradation can exceed synthetic processes (i.e. there is a steady loss of body collagen). The intake of hydrolyzed gelatin appears to be an alternative route to getting chondrocytes (cartilage producing cells) and osteoblasts (bone forming cells) of the body sufficient amounts of these important amino acids for making structural proteins. Although chondrocytes are critical for collagen formation, their number is limited and their ability to form this much needed protein is influenced by heredity, age, physical activity (too little or too much), injury, and availability of nutrients.

Although bone metabolism is quite complex and not fully understood, there is a growing number of studies showing the intake of just ten grams per day of hydrolyzed gelatin is effective in greatly reducing pain, improving mobility and overall bone/cartilage health. Several randomized, double-blinded, crossover trials have shown improvements in symptoms related to joint pain (Adem et. al. Therapiewoche, 1991). The people at Knox (the Jello people) have made a product specifically for bone health and joints called NutraJoint. It contains hydrolyzed gelatin, calcium , and vitamin C. Calcium is of obvious importance to bone health and vitamin C is an essential and limiting nutrient for connective tissue formation. NutraJoint is cheap, has no side effects, and tastes good. I recommend one packet mixed with OJ with breakfast for people suffering from joint pain.

Cetyl Myrist..what?

A fatty acid with the long and hard to pronounce name of Cetyl Myristoleate has been receiving a good deal of attention by researchers concerned with joint pain and health. Being it's difficult for the reader to pronounce-or for me to write for that matter-I will just call it CMT for the remainder of this article, OK?

Discovered by a researcher at the National Institutes of Health (NIH), CMT looks very promising as a compound that greatly reduces joint pain due to a variety of causes. In animals CMT was found to be very protective of joints from different chemicals that would normally cause arthritis in these animals. Though the human research at this time is not as solid as we would like, CMT has already developed a following with some alternative medical practitioners and by those who suffer from joint pain. Several bodybuilders I work with swear by the stuff though I cant vouch for it at this time as I have had no personal experience with this product. Also, its effects seem to work rather quickly and relatively small amounts can be used. 12-15 grams spread out over an entire month appear to be effective. Exactly how CMT works is unclear but it might have something to do with a reduction in pro-inflammatory prostaglandins (see below) or some other mechanism. EHP Products Inc. makes a CMT product that is endorsed by the researcher who discovered it. They can be reached at 888-EHP-0100. A company called G nS Marketing also sells CMT (they call it CMO) and can be contacted by calling 800-829-1514.

Flax oil for everything!

Many bodybuilders and other athletes are starting to see the many benefits of flax oil for all sorts of uses. One obvious use of flax oil is a reduction in pain due to any type of inflammatory condition, including joint troubles. To understand why this is so, the reader must now endure a crash course in the topic of essential fatty acids and the many products made by these fatty acids found in the body. If you already know all this stuff you can skip over this material, but if you don't know it, you will need this information for the rest of the article.

The definition of an essential nutrient is anything the body cannot make itself and therefore must be obtained from the diet. We need to eat an assortment of vitamins and minerals, approximately nine to eleven amino acids, and two fatty acids to stay alive and healthy. The two essential fatty acids (EFAS) are called linoleic acid and alpha-linolenic acid. The first being an Omega-6 fatty acid and the latter being an Omega-3 fatty acid. If the term "Omega-3 fatty acid" rings a bell for you it should. Fish oils are also well publicized and researched Omega-3 fatty acids (see below) that have been shown to have many benefits. "So what does all this have to do with my aching joints?" you are thinking. Ok, here is the skinny on why you had to endure that previous section. Flax oil is exceptionally high in Omega-3 fatty acids (alpha-linolenic acid). Omega-3 fatty acids, from fish, flax, etc., have been shown in the scientific/medical literature to reduce inflammation of any kind.

Remember the "-itis" part of the word relating to joint problems? How do you think non- steroidal anti- inflammatories work? They reduce inflammation, but they also come with potential side effects and health problems. So how does flax oil do this wonderful thing? From both of the essential fatty acids the body makes something called prostaglandins. Prostaglandins are very short lived hormone-like substances that regulate cellular activity on a moment to moment basis. Prostaglandins are directly involved with regulating blood pressure,inflammatory responses, insulin sensitivity, immune responses, anabolic/catabolic processes, and hundreds of other functions known and yet unknown. The long and the short of all this, without going into a long and boring biochemical explanation, is: Omega 3 fatty acids are responsible for forming the anti -inflammatory prostaglandins and the Omega 6 prostaglandins are responsible for making many of the pro-inflammatory prostaglandins, and other products derived from EFAS. A high intake of Omega 3 oils reduces inflammation (and pain) by this mechanism. Obviously, it's a lot more complicated than that, but hey, I only have so much space to write.

People who add in 1-3 tablespoons a day of flax oil to a protein drink, or over a salad, often notice a reduction in pain in their joints, not to mention all the other great things EFAS can do for the hard training bodybuilder. Flax oil can be found in any large health food store under such brands as Flora, Omega, Barleans, and several other names (Even better than flax perhaps, Udo's Choice oil is a great blend of different oils. More info can be found at Udo's site connected to the links section of this web page).

High quality kitchen sink formulas

I call these products "kitchen sink formulas" because they add in just about everything you could want in a formula for painful joints. Two high quality product of this type that come to mind are the Natural Pain Relief products by Inholtra and The Life Extension Foundation. These products contain Glucosamine(s), Chondroitin Sulphate, the fish oils EPA/DHA, Gamma-linoleic acid (GLA), vitamin E, fat soluble vitamin C (ascorbyl palmitate), and Manganese aspartate. "So what does all this stuff do?" you are asking yourself. Briefly:

Glucosamine is considered by many as one of the best natural products for the treatment and prevention of cartilage degeneration. It is in essential part of cartilage, synovial fluid, and other components of joints. Chondroitin sulphate is related to glucosamine and is part of a family of modified sugars that form structural molecules in cartilage. As mentioned previously, the Omega 3 fish oils (EPA/DHA) are renowned for improving pain and inflammation in joints and other areas of the body. GLA is a fatty acid derived from the Omega-6 class of fatty acids but has been shown to have many properties similar to that of the fish oils/flax oil in its ability to reduce inflammation through the production of the favorable anti-inflammatory/anti-auto immune prostaglandins.

The anti - oxidants vitamin E and C are added because it is well known that free radical pathology is part of the damage that takes place in the joints. Finally, the trace element manganese is needed as a co- factor in many enzymatic processes related to cartilage synthesis and cartilage integrity. Now you know why I call them kitchen sink formulas! Taken singularly, the above ingredients appear to have marginal effectiveness. Taken as a complex, they appear to be very synergistic.

These are very well rounded and complete-though slightly different-formulas for people looking for some relief to their joint troubles, or any chronic inflammatory condition for that matter. However, I have found most people will need to take more than the manufacturer recommends to see real results, though this is not true 100% of the time.

Conclusion and Recommendations

If you are one of the millions of people who suffer from chronic joint pain when you hit the gym, first make sure you are not making any of the most common mistakes outlined in the beginning of this article. Secondly, get an opinion from a good sports medicine doctor as to exactly what your problem is. You don't want to self diagnose what could be a serious problem. Finally, start with one of the above products and see if it improves your condition. Wait at least a few months before you make your assessment. Add in a second or third product if you don't think you are getting the results you want, which would be of course less pain and greater mobility through the joint in question.

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Bellina thanks for that great info again much appreciated, by the way hows things? and is that you in the Avatar?

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Posted by: pSimonkey
Bellina thanks for that great info again much appreciated, by the way hows things? and is that you in the Avatar?

Yep that is me..."things" are good.

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Posts: 63

cissuss rx by usplabs @ changed ENDED my joint problems. I train 2-3 times a day as an MMA fighter and consistently battled joint pain. Glucosamine chondroitin only helped a little. I would wake up creaky and sore each day even if I trained only once that day. Cissus COMPLETELY cleared up any soreness or stiffness. I feel better than I did at 18.

struggle---and shine on

Just because there is a goalie, doesnt mean you can't score.

Satisfaction is the death of desire.

Practice makes perfect; and I love 2 practice!!
-Dan Gable

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I recommend Omega Flex from Custom. Contains Celedrin, MSM and Chrondrotin.

I also take NutraJoint(Type II gelatin) with Glucosamine as a supplement to this.

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I swear by alkanalising the body, and drinking water like a camel.
Use bi-carb(half a flat teaspoon), vinegar(2-3 tablespoons) or lemon juice(pure 3-4 tablespoons), first thing in the morning and last thing at night.It must be on an empty stomach.Wait at least half an hour b4 eating, drink water.
Eased my joint pains(too numerous to mention)
This is very important, as eating protein(and many other foods), cause our bodies to become acidic over time,with deposits in the joints(ask any Gout sufferer)
I am 40 plus BTW.
There are many other commercial preperations available as well, I have tried numerous, which are not neccessarily better, only more expensive.

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This thing is worth reading:

Guide to joint support

by Jim Wright, PHD

If you train hard and heavy, you're exposing vour joints and connective tissue to considerable repetitive wear and tear. It may not be enough to sideline you � at least for the first few years � but it'll catch up to you. Over time. many hardcore bodybuilders end up with serious if not chronic joint aches that cut into their ability to train with gusto. What fun is that?
For years, bodybuilders and other athletes looked to aspirin and other anti-inflammatories to relieve sore and abused joints. Fortunately for us gym rats � especially the eft-injured and older ones � the times, they are changing for the better, thanks to a true success story of modern supplementation. Researchers have discovered that glucosamine, chondroitin and a few other substances can actually help rebuild connective tissue and reduce the ravages of doing tens of thousands of muscle-building reps.

What Is Connective Tissue?
Connective Tissue includes the dermis of the skin, tendons, ligaments, cartilage, bone matrix, fasciae, aponeuroses (fibrous membranes that connect muscles or muscles to bone), and the looser supporting tissues within and around organs. The main functions of connective tissue are to take the stresses of movement and to maintain the shape of the body. Connective tissue is made up of primarily collagen, but also elastin and reticulin; extracellular ground substance (basic material from which a specific type of tissue develops), also called proteoglycan, in which the protein fibers are embedded; and cells that make the ground substance � chondroblasts, fibroblasts and neuroblasts. The characteristics of substance to protein fibers.
Ground substance is composed mainly of glycosaminogtycans (these were once called mucopolysaccharides, because of their presence in mucus) and proteins. Ground substance is found in the lubricant (synovial fluid) in all joints and in tendon sheaths, bursa, corneas, spinal discs and bones.


The aspirin-takers I referred to above are not just squirrelly trainers using sloppy form. Many are masters of biomechanics, ultimate technicians who view each exercise as an art form and strive to perform every rep flawlessly according to their individual capacity and body structure. If you're ambitious and regularly use heavy weights in your major exercises, you damn well better be doing more than counting reps.

Think of heavy training as a repetitive-stress injury. Ponder the effects of serious training loads and stresses; the friction; the usual left-right and front-back asymmetries in strength; how stabilizers fatigue before prime movers, potentially decreasing your stability and altering neuromuscular firing patterns; and think of all these things as having the potential to increase your risk of injury. It's amazing that bodybuilders don't have more debilitating injuries than they do.
Injuries and the physical stress associated with heavy resistance exercise take their toll on joint structures. Consider cartilage, for example, which you might know as the glistening white coating at the ends of the bones in chicken drumsticks.
Wear and tear of cartilage leads to osteoarthritis, a potentially painful and even incapacitating medical condition that affects as many as 20 million Americans and more than half of people over the age of 60. Age is a risk factor, even without injury, as the balance in the enzymes that regulate the production of collagen� the toughest of the connective tissue proteins and the most prominent in cartilage � shifts to favor break down rather than synthesis. Once an injury or repetitive stress damages the cartilage surface, osteoarthritis can result and lead to the destruction of the cartilage structure itself.
I can personally attest to the reality of that. I'm 52 years old and a long time freak about good exercise form. When my eminent orthopedist confronted me with the results of a recent magnetic resonance imaging (MRI) scan and the fact that I have "80-year-old" shoulders � from the standpoint of the cartilage � I got the message.
I didn't stop training, and I won't, but I did start seriously hitting the joint supplements. Although only time and another MRI will tell for sure. I believe the supplements have made a big difference. I wish I had begun taking them sooner rather than later. That's a mistake you don't have to make.

Any serious bodybuilder knows you can tear yourself down at any age. Even if you have your training act together, you can't help but literally wear down some tissues, such as those between joints, doing rep after rep. Unless you suffer acute trauma or develop an inflammation from severe overuse or poor form, though, you may not know you're developing a joint problem. By the time you do notice a long-term overuse injury, you'll be faced with a long road back.


How do you pro-tect against this potentially harsh training setback? Modern sports science has come to the rescue by developing supplements for crucial connective tissue that should be part of every serious bodybuilder's arsenal. Let's look at the three most important of these supplements: glucosamine, chondroitin sulfate (CS) and hydrolyzed collagen.

� Glucosamine

Like chondroitin sulfate and collagen, glucosamine is produced naturally in the body. It is the most fundamental building block for many critical compounds that make up connective tissues.
Glucosamine is an essential component of cell membranes (consider the implications of that) and cell surface proteins, as well as of molecules that hold our cells together.
Arthritic and damaged tissues show a much higher than normal demand for glucosamine.
Directly or indirectly, glucosamine plays a part in the formation of cartilage, tendons, ligaments, synovial fluid, skin, bone, nails, heart valves, blood vessels and mucus secretions of the digestive, respiratory and urinary tracts. Glucosamine also has a role in the synthesis of transport molecules. immunological proteins (interferon, immunoglobulins), hormones (gonadotropins, thyroid stimulating hormone), enzymes and other important substances.
Although tested extensively in cases of osteoarthritis, and prescribed as a drug in some European countries, glucosamine has been studied only once in athletes, in which case it helped heal "jumper's knee." However, other data and our own experiences suggest that it should be very helpful for sore shoulder joints and any other joint degeneration or "creakiness."
All human studies of glucosamine sulfate have used 1.500 milligrams (mg) per day (three doses of 500 mg each).
It is best to take glucosamine in the morning and before bedtime, since it has a long half-life in serum. If faster results are desired, increase the dose by taking 1.000 mg twice daily, although true joint repair will still be a slow process.
Glucosamine hydrochloride, also on the market, has the same effects as glucosamine sulfate at a lower cost. Glucosamine sulfate turns into glucosamine hydrochloride in the stomach.
Since glucosamine has a different mechanism of action than nonsteroidal anti-inflammatories (NSAIDs like asprin and ibuprofen), it's possible that the two may have a synergistic effect in alleviating some types of inflammations. So, you may be able to significantly reduce the amount of NSAIDs you take (perhaps as much as two to three times less), with no loss of effect, if it's necessary to take them at all.

Chondroitin Sulfate

CS is one of today's most misunderstood supplements. Extracted from bovine and pork tracheas, as well as shark cartilage. CS, like glucosamine, serves as both a building block and a direct stimulus to the synthetic process for new cartilage. In addition to stimulating repair in cartilage cells, CS can block the enzymes that damage joints, doing double duty for joint health.
There have been more and better-designed human studies with CS on arthritis than there have been with glucosamine sulfate. Some of that research has lasted one to two years and has involved more than a thousand subjects. Like glucosamine, CS is used as a drug in some European countries for osteoarthritis (and for clogged arteries).
Purified CS is well-absorbed in humans, as demonstrated by numerous sophisticated investigations.
Many studies of people taking CS have shown slow-acting but long-lasting reductions in pain and improvements in joint function. Slow-acting means you may not really notice much change for several weeks (most of the research shows significant benefits after four to eight weeks, and definitely after three months of administration). However slowly, the benefits will accumulate.
Take anywhere from 800-1,200 mg of CS per day, in two divided doses (it has a 12-hour half-life). This regimen matches what's been effective in extensive human studies on arthritis, although once-a-day dosing also may be effective for you.
Scientists have emphasized that the CS used in the clinical studies has been extracted and purified to contain a high percentage of the supplement (up to 97%). It's likely that the processing and purity of the CS could significantly alter the metabolic fate and therapeutic results.
Bottom line: Some available products may have a lower percentage of actual CS, which in turn could dramatically influence the dosage required for therapeutic efficacy. Thus, if you use one brand as directed for a prolonged period and get no results, try another. Don't assume that CS has no efficacy for you; it may be the specific product that's at fault.

� Hydrolyzed Collagen

Collagen is the major protein in the body � it makes up approximately six percent of total bodyweight. It is found in all tissues and is our main structural protein, giving our bodies their shape. It literally holds us together.
Collagen is the primary nonwater component of all connective tissues, including cartilage. Cartilage contains type II collagen (which you might see listed on supplement labels), plus smaller amounts of other collagen types. Other connective tissues contain mostly types I and III collagen. Collagen may be more familiar to you as gelatin (found in gelatin desserts); it's also used as a thickening agent in many foods.
This supplement was once sold in a liquid form and promoted as pre-digested protein. A muscle-building protein supplement it's not, however, because though it is obtained from animals, its amino acid profile leaves much to be desired. However, it is a great supplement for your joints.
Hydrolyzed collagen (Arthred G) is a patented collagen that has been predigested by enzymes (not acids). Its use is supported by human studies that show significant relief of arthritic symptoms, although its effects are slower than those generated by glu-cosamine or CS.
Why take it then? Hydrolyzed collagen supplies collagen-specific peptides and amino acids that may stimulate repair differently from glu-cosamine or CS. and perhaps may inhibit some degradative enzymes. The only catch is the dose: 10 grams per day. To prepare it, mix a powdered form of the supplement into a liquid. CS is not expensive, and it doesn't have the gel-forming properties of regular gelatin.
Actually, hydrolyzed collagen should work especially well when combined with glucosamine and CS. There are no studies to confirm this, though. However, since each of these supplements has unique effects on cartilage, and since all overlap in their stimulatory effects on synthesis of joint components, it makes sense � and my observations and personal use confirm � that a combination of the three would result in greater, faster and longer-lasting effects than any one or even two of these ingredients.


There are other joint supplements available (see "The Rest of the Story: Other Joint Helpers"), but glucosamine, chondroitin and collagen should be your starting point. They offer real help for sore joints, as millions of users can readily attest. And they're all normally produced by and found in the human body in large amounts, plus they are present in many foods. They're virtually free of side effects, well-tested in humans, and are what the body uses to heal its own joints. They do work gradually, so you have to take them for a while � anywhere from four to eight weeks � before results are noticeable.
Most bodybuilders will benefit from repeated use of these supplements. Improvements obtained via glucosamine appear to be retained only for an average of six to 12 weeks following cessation of a six-week period of treatment. The situation with CS is similar. There is no evidence whatsoever of toxicity and there appear to be no contraindications to use of these in patients with circulatory disease, liver disorders, lung disorders, diabetes or depression.
If you train hard and heavy, and plan on doing it for a while, then these supplements should become a mainstay in your program sooner rather than later. Even if you've never had any connective tissue problems, we feel strongly that it would be in your best interest to begin using joint aids, if not year-round, then at least periodically, say for six to 10 weeks at a time, several times a year.

Other Joint Helpers

Several supplements are being promoted, some more aggressively than others, as joint supporters and antiarthritics. For the latest perspective, I interviewed Luke Bucci, PHD, an internationally recognized expert on connective tissue rejuvenation and author of Healing Arthritis the Natural Way (Summit Publishing Group, 1997 revised). The following are his comments.

� S-adenosylmethionine (SAMe)
SAMe really works. It has the backing of many human clinical trials and is actually an approved drug tor osteoarthritis in at least one European country. The only problem is, the effective dose is on the order of 1,500 mg per day, which is very expensive (about S5-6 daily at retail). SAMe is unique among nutrients in that it has some immediate analgesic activity. It seems to be completely sate, and it's also a good antidepressant, so people using it feel better mentally.

� Essential Fatty Acids (EFAs)
EFAs may make a modest but slow contribution to the alleviation of symptoms of rheumatoid arthritis, which makes them less interesting to bodybuilders with connective tissue injuries (rheumatoid arthritis is related to auto-immune problems rather than to wear and tear). Flax and evening primrose oils have not done well in human clinical trials, even at high doses. Eating lots of fatty fish � salmon, even sardines � is the way to go if possible. Otherwise, you need 10-12 fish-oil capsules daily. There have been a number of positive human clinical trials, but it takes eight weeks or more to see results. EFAs are good for so many other things that you should do what you can to increase intake anyway.

� Bromelain
This substance or any potent protease (papain, trypsin, chymotrypsin and fungal proteases) is very good for acute traumatic injuries or active inflammation. Since doses are not standardized and stability is poor, an individual needs to take four to six pills tour times daily tor a week, always on an empty stomach. They're not very good tor chronic conditions, but they do seem to reduce pain somewhat, and they definitely seem to enhance healing. Combinations of different enzymes appear to work better than a single enzyme. This is one supplement that can be felt overnight and merits a big thumbs up for acute injuries.

� Curcumin
Derived from the herb turmeric, which is used to make curry, curcumin does have a few human studies behind it However, the data show it to be about 10 times less potent than indomethacin (another NSAID), suggesting that 2,000 mg would be needed daily for reduction of pain and inflammation. It is a very good antioxidant, but it gets a little costly at effective doses. There are also suggestions that it's good for prevention of cancer and heart disease. Smaller amounts, such as those sprinkled in many supplement products, have unknown efficacy.

� Vitamin C
This valuable vitamin is a grossly overlooked way to slowly reverse osteoarthritis, though it does have to be used in high doses for a long time. Although there are no human studies for its use for arthritis, animal studies suggest that if humans take about four to five grams per day, it should really help connective tissue problems. Anecdotal evidence and one study in human osteoarthritis suggest that four grams per day is a threshold of effect. Test-tube work shows that vitamin C and glucosamine are the only known nutrients that can actually activate chondrocytes to produce both collagen and proteoglycans. It's cheap, it's safe, and although its efficacy is not open and shut, I would highly recommend it

� Cetyl Myristoleate (CMO)
CMO seems to be of little or no value to bodybuilders. At present, there is only one questionable human study from the inventor of the patented form of CMO and one animal study. CMO may work as a nonspecific immune adjuvant, which would make it good mostly for rheumatoid arthritis. The commercial sources do not appear to match the patented CMO material in quality, and it's very costly.

� Methylsulfonomethane (MSM)
This supplement has come and gone over and over for the last 25 years. The same old anecdotal data from Stanley W. Jacob, MD, coauthor of The Miracle of MSM. are still the only available data, and, although not worthless, are of limited value.
MSM is supposed to be a source of sulfur, which would theoretically provide increased amounts of methionine and glutathione inside of cells. This remains to be proved in humans after oral consumption. Doses used (notice 1 did not say effective doses, since there is no proof of efficacy) range from 500 mg to 10 grams.
MSM seems quite innocuous, fortunately. Many consumers have bought into the sulfur-for-chondroitin-sulfate-synthesis line of thinking, but there's no evidence this happens in humans despite the fact that some pharmaceutical companies do add sulfur groups to their CS products.MSM has been called dry DMSO, and has been given imaginary antiinflammatory properties. MSM is all fluff and no substance, but it's cheap; and with all the testimonials (reminds me of the old days of protein supplements), it apparently makes a good enough story to sell.

�Shark cartilage
Shark cartilage was actually the first kid on the block aggressively promoted as a potential joint rejuvenator for athletes. Its track record over the last half-dozen years isn't very impressive, though. Shark cartilage does contain minerals, collagen and chondroitin sulfates that can help maintain healthy connective tissue. It also contains small proteins that may educe the formation of new blood vessels � a property called antiangiogenesis. This is important for joints because the movement of new blood vessels into normally avascular cartilage leads to calcification and fragmentation, like water getting into the cracks of concrete, then freezing and eventually breaking up the cement. More recently, proprietary extracts of shark cartilage have been developed that have anticollagenase activity, meaning that they block the body's normal enzymes that break down cartilage, which give the body's synthetic enzymes an opportunity to "catch up" and get into a "positive cartilage balance." The extract is very expensive, but I can personally attest to its efficacy. The cost has so far prevented sports nutrition companies from marketing it.
The original dosing recommendation for joint pain for shark cartilage outlined in the popular book Sharks Don't Get Cancer (by 1. William Lane and Linda Comae) was a single 740/750 mg capsule per 11 pounds of bodyweight (or 20
caps for a 220-pound person), divided between three daily doses for three weeks. Once improvement is noted, the dose
can be reduced by two-thirds (to one cap per 30-33 pounds of bodyweight). If there's no improvement within 30 days, then even the original proponents of shark cartilage suggest that it's not going to help you. Shark cartilage may have beneficial immune system effects, but they would be very slow-acting.
With no relevant controlled studies, the jury's still out on this supplement.


� First of all, train correctly!
� Take glucosamine sulfate in dosages of 1,500 milligrams (mg) per day (three 500-mg doses, two of these in the morning and one before bedtime). For faster results, take 1,000 mg twice daily.
� Take chondroitin sulfate in total daily amounts of 800-1,200 mg divided over two doses.
� Take hydrolyzed collagen in doses of 10 grams per day in powder mixed with any liquid.
� A combination of the above three supplements should work synergistically. Try taking all three together.
� Give yourself at least eight weeks to feel benefits from these supplements.
� Use them for six to 10 weeks at a time, several times per year, or, preferably, year-round.
� Make sure your essential mineral and antioxidant intake is up to snuff.
� Give some of the other supplements listed in "The Rest of the Story" sidebar a try for extra relief.
� Make sure you are giving yourself enough recovery time between workouts.